Western Australia is leading the charge in the prevention of preterm birth

WA has lowered its preterm birthrate and is now pushing the rest of the nation to do the same.

Babies born prematurely, particularly before 34 weeks’ gestation, are at increased risk of serious complications involving the gut, lungs, heart and brain. They often have lifelong health problems associated with vision, hearing and mental capacity.

Five years ago the WA Preterm Birth Prevention Initiative began, encompassing a public health campaign called The Whole Nine Months, a dedicated preterm birth prevention clinic at King Edward Memorial Hospital and a Statewide outreach program for healthcare practitioners.

The Australian Preterm Birth Prevention Alliance is now rolling out The Whole Nine Months program Australia-wide.

“We are making the West Australian program national ... it is a world’s first and everyone is watching us,” Professor John Newnham, obstetrician and chief scientific director at Women and Infants Research Foundation, said.

Together with decades of medical advancements, the State is on track to make further inroads to ensure the health of women and their babies.

Know your risk

The most important thing a woman can know is the length of her cervix come mid pregnancy, said Professor Newnham. Of all the areas he has directed his considerable energy towards, ensuring every mid-pregnancy ultrasound in WA includes a cervix length measurement has been his priority.

A short cervix at 16-24 weeks is a predictor for preterm birth. Identifying this at the standard 19-week ultrasound means the mother can immediately start progesterone, a treatment that will take half of those at risk to full term.

While short cervical length is a well-known risk factor, Professor Newnham said no one had been able to implement the discovery across a population.

“We made sure every person that provided health care in WA, from Kununurra in the north to Albany in the south, understood that measurement needed to be done,” Professor Newnham said.

“We hammered that really hard and it was completely successful. I haven’t seen an ultrasound report from a mid pregnancy scan in WA in years without the cervix length included.”

Combined with the prevention clinic at King Edward and education of health professionals, the initiative produced fast results.

Camera IconProfessor John Newnham, obstetrician and chief scientific director at Women and Infants Research Foundation. Credit: Iain Gillespie/ The West Australian

“After 18 months, the rate of preterm birth was lowered by almost 8 per cent; most of the reduction was seen in the late preterm birth group (greater than 34 weeks gestation), with a matching rise in deliveries after 39 weeks.”

“The overall reduction equates to the prevention of almost 200 babies being born too early,” said Professor Jeffrey Keelan, head of laboratories at UWA’s division of obstetrics and gynaecology.

Despite these great inroads at KEMH and some other areas, Dr Newnham said there is plenty more to be done.

“What we have observed since is the effect that has been continued in King Edward and areas that we are very active in, but we are worried it is deteriorating outside,” he said, adding he is about to start another lap of the State to ensure rates continue to improve.

Every day counts

In the past full term was considered “around 37 weeks”. Wrong, said Professor Newnham.

“There has been a progressive increase in deliveries down to 37, 36 weeks for non-medical reasons, FIFO workers, sick of being pregnant, doctor going on holidays, various reasons,” Professor Newnham said.

“Across Australia and the developed world there was this increasing trend as people thought that 37 weeks was OK, and the reason they thought it was the definition, inherited from 50-60 years ago, of term was 37 weeks. It was never right but it led us to think a baby is fully cooked at 37 weeks, but it is far from cooked at 37 weeks.”

WA’s Raine Study, one of the biggest successful prospective cohorts of pregnancy, childhood, adolescence and now early adulthood to be carried out anywhere in the world, highlights the dangers of a planned early birth.

“The study showed, to be born at 37 or even 38 weeks carries huge implications at school age in terms of learning ability and externalising behaviour. That last little bit of pregnancy is terribly important for brain development,” Professor Newnham said.

Professor Keelan explains that every week in the womb counts as it allows the foetal organs to mature and develop ready for life outside.

He says babies born less than 28 weeks’ gestation have up to a 50 per cent chance of major morbidity but this falls to less than 10 per cent at 32 weeks and 2 per cent at 36 weeks.

Neonatal deaths have declined by around a third over the past decade in Australia thanks to neonatal intensive care unit practices and improved management of sick newborns.

WA’s medical fraternity states no pregnancy is to be ended until about 39 weeks without a medical reason.

Looking to the future

Researchers at UWA and King Edward are a third of the way through a study to develop a low-cost test to identify women at risk of delivering a preterm baby.

The study will recruit more than 6000 women from King Edward and St John of God hospital, Subiaco.

“We know that bacterial infections of the womb are a major cause of early birth but until now we haven’t been able to identify women at risk with any degree of accuracy, so antibiotic treatment hasn’t been particularly successful or widely adopted,” Professor Jeffrey Keelan said.

“The new test enables us to identify women at risk early in pregnancy, allowing timely treatment with antibiotics and probiotics to remove the bacteria, restore a healthy vaginal microbiome and enable the pregnancy to continue until full term.”

He said the combined test and treatment program could reduce the preterm birthrate in Australia up to 30 per cent.

The role of fish oil in reducing rates of preterm births is also being investigated by researchers, said Professor Keelan.

He says the dose, duration and indications for the therapy are still not clear.

Work is also being conducted by Australian and Canadian researchers on a new drug which can block inflammation, prevent preterm birth and spare the foetus from the harmful effects of inflammation in utero, said Professor Keelan.

The project is under way in four centres, including Perth.

Risks for early delivery

Professor Jeffrey Keelan, head of laboratories at UWA’s division of obstetrics and gynaecology, said some of the known modifiable and unalterable risk factors for preterm birth include: